[unreadable] [unreadable] Emergency Department (ED) crowding has become an unresolved national crisis for more than a decade. Crowding affects the safety of patients on a daily basis and exposes them to an increased risk of harm through decreased access to scarce critical resources. The lack of an integrated systems framework and the difficulties of measuring potential crowding factors in real-time contribute to the failure of finding effective solutions. The goal of this project is to apply information technology to implement a conceptual, nationally developed, [unreadable] consensus-based measurement framework to characterize ED crowding. The crowding [unreadable] measures will be used to develop a probabilistic, early warning decision support system that is able to [unreadable] predict ED diversion in real time. The decision support system will be integrated with our advanced ED [unreadable] information system infrastructure. In a prospective pilot evaluation we will study the impact of the [unreadable] probabilistic decision support system's ability to ameliorate reversible causes of ED crowding and examine the system's accuracy for predicting ED diversion. [unreadable] [unreadable] The following objectives will be achieved: [unreadable] [unreadable] Aim 1: Create an integrated health information system infrastructure that allows the real-time collection of ED crowding measures. [unreadable] [unreadable] Aim 2: Collect ED crowding measures prospectively during a 4-month period as the foundation for [unreadable] developing an early warning system for ED overcrowding. [unreadable] [unreadable] Aim 3: Develop and implement a real-time, probabilistic decision support system for ED crowding. [unreadable] [unreadable] Aim 4: Prospectively evaluate the impact of the decision support system on ED crowding during a pilot evaluation study. [unreadable] [unreadable]